Infectious Diseases introduction and history.ppt

INFECTIOUS DISEASES
SARDER ARIFUZZAMAN
SR. LECTURER
DEPARTMENT OF PHARMACY
WORLD UNIVERSITY OF BANGLADESH

INFECTIOUS DISEASE DEFINED
Infectious Diseases are defined as:
“Disorders caused by organisms,
such as bacteria, viruses, fungi or
parasites …which can be passed
from person to person. Some are
transmitted by insect or animal
bites while others are passed by
ingesting contaminated food or
water or being exposed to
organisms in the environment.”

SPREAD OF DISEASE
• Endemic: ”Constant presence of a disease or infectious
agent within a given geographic area. The usually
prevalence of a given disease within such an area.”
• Epidemic: “Occurrence in a community or region of cases
of an illness or outbreak clearly in excess of expectancy.”
• Pandemic: ”Occurring over a wide geographic area and
affecting an exceptionally high proportion of the
population, i.e. malaria.”

TYPES OF INFECTIOUS DISEASES
 Viral infections
 Bacterial infections
 Fungal infections
 Parasitic infections
 Transmissible spongiform
encephalopathies (TSEs/prion
diseases)

• Viral infections. Viruses are a piece of information
(DNA or RNA) inside of a protective shell (capsid).
Viruses are much smaller than your cells and have no
way to reproduce on their own. They get inside your cells
and use your cells’ machinery to make copies of
themselves.
• Bacterial infections. Bacteria are single-celled
organisms with their instructions written on a small piece
of DNA. Bacteria are all around us, including inside of
our body and on our skin. Many bacteria are harmless or
even helpful, but certain bacteria release toxins that can
make you sick.

• Fungal infections. Like bacteria, there are many different
fungi. They live on and in your body. When your fungi get
overgrown or when harmful fungi get into your body through
your mouth, your nose or a cut in your skin, you can get sick.
• Parasitic infections. Parasites use the bodies of other
organisms to live and reproduce. Parasites include worms
(helminths) and some single-celled organisms (protozoa).
• Transmissible spongiform encephalopathies (TSEs/prion
diseases). TSEs are caused by prions — faulty proteins that
cause other proteins in your body, usually in your brain, to
become faulty as well. Your body is unable to use these
proteins or get rid of them, so they build up and make you
sick. Prions are an extremely rare cause of infectious diseases.

COMMON INFECTIOUS DISEASES
By viruses:
• Common cold
• The flu (influenza)
• COVID-19.
• Stomach flu (gastroenteritis)
• Hepatitis
• Respiratory syncytial virus
(RSV)
By bacteria:
• Strep throat
• Salmonella
• Tuberculosis
• Whooping cough (pertussis)
• Chlamydia, gonorrhea and
other sexually transmitted
infections (STIs)
• Urinary tract infections (UTIs)
• E. coli.
• Clostridioides difficile (C. diff)

COMMON INFECTIOUS DISEASES
By fungi:
• Ringworm (like athlete’s
foot)
• Fungal nail infections
• Vaginal candidiasis (vaginal
yeast infection)
• Thrush
By parasites:
• Giardiasis
• Toxoplasmosis
• Hookworms
• Pinworms

RISK FOR GETTING INFECTIOUS DISEASES
• Those with suppressed or compromised immune systems, such
as those receiving cancer treatments, living with HIV or on
certain medicines.
• Young children, pregnant people and adults over 60.
• Those who are unvaccinated against common infectious diseases.
• Healthcare workers.
• People traveling to areas where they may be exposed to
mosquitoes that carry pathogens such as malaria, dengue
virus and Zika viruses.

COMMON COMPLICATIONS ARE ASSOCIATED WITH
INFECTIOUS DISEASES
Many infectious diseases resolve without complications, but some
can cause lasting damage.
Serious and life-threatening complications of various infectious
diseases include:
• Dehydration: Fever, vomiting, diarrhea.
• Pneumonia: Respiratory illness (viral or bacterial).
• Sepsis: Bacterial infections.
• Meningitis (swelling of the brain): Multiple causes, including
bacterial, viral, fungal and parasitic infections.
• AIDS: HIV.
• Liver cancer: Hepatitis B, hepatitis C.
• Cervical cancer: Human papillomavirus (HPV).

SYMPTOMS OF INFECTIOUS DISEASES
Symptoms of infectious diseases depend on the type of illness.
Fungal infections usually cause localized symptoms, like rash
and itching. Viral and bacterial infections can have symptoms in
many areas of your body, like:
• Fever
• Chills
• Congestion
• Cough
• Fatigue
• Muscle aches and headache
• Gastrointestinal symptoms (diarrhea, nausea, vomiting)
It’s important to see a doctor if you have any chronic (ongoing)
symptoms or symptoms that get worse over time.

INFECTIOUS DISEASES SPREAD
• Depending on the type of infection, there are many
ways that infectious diseases can spread. Fortunately,
in most cases, there are simple ways to prevent
infection.
• Your mouth, your nose and cuts in your skin are
common places for pathogens to enter your body.
Diseases can spread:
• From person to person when you cough or sneeze. In
some cases, droplets from coughing or sneezing can
linger in the air.
• From close contact with another person, like kissing or
oral, anal or vaginal sex.

INFECTIOUS DISEASES SPREAD
• By sharing utensils or cups with other people.
• On surfaces like doorknobs, phones and countertops.
• Through contact with poop from a person or animal with an
infectious disease.
• Through bug (mosquito or tick) or animal bites.
• From contaminated or improperly prepared food or water.
• From working with contaminated soil or sand (like
gardening).
• From a pregnant person to the fetus.
• From blood transfusions, organ/tissue transplants or other
medical procedures.

DIAGNOSIS AND TESTS
Usual diagnoses of infectious diseases or more lab tests. Your
provider can look for signs of disease by:
• Swabbing your nose or throat.
• Getting blood, pee (urine), poop (stool) or spit (saliva)
samples.
• Taking a biopsy or scraping a small sample of skin or other
tissue.
• Getting imaging (X-rays, CT scans or MRIs) of affected parts
of your body.
• Some test results, like from a nose swab, come back quickly,
but other results might take longer. For instance, sometimes
bacteria has to be grown in a lab (cultured) from a sample
before you can get your test result.

Infectious Diseases introduction and history.ppt

Infectious Diseases in History
1346, during a plague outbreak,
Mongols catapulted victims into a
city.
1520, Narvaez expedition to Aztec
empire spread smallpox.
1763, during French and Indian
War (Pontiac’s Rebellion), blankets
and handkerchiefs were given to
Native Americans.

1793: Philadelphia
yellow fever
epidemic.
Nearly 10% of city’s
50,000 population
died.

20,000 had fled the city to Germantown 6 miles distance upon
the encouragement of President George Washington.
Secretary of State, Thomas Jefferson, “left with one clerk,”
found his effectiveness impacted.

Smallpox in History
“The disease is thought by some scholars to
have arisen among settled agricultural
populations in Mesopotamia as early as the
5th millennium BC and in the Nile River
valley in the 3rd millennium BC.
“The mummified body of the Egyptian
pharaoh Ramses V (died c. 1156 BC) bears
evidence of pustules characteristic of
smallpox.”

Smallpox in History
“It is possible that smallpox was behind the great plague of
Athens in 430 BC, recorded by the Greek historian
Thucydides, and a devastating plague carried to Italy by a
Roman army returning from Mesopotamia around AD 165.”
“A huge pandemic reached
from Europe to the Middle
East in 1614, and epidemics
arose regularly in Europe
throughout the 17th and
18th centuries.”

Smallpox in History
“Smallpox was … one of the first diseases to be controlled by
a vaccine, due to the experiments of English physician Edward
Jenner in 1796.”
1967: World Health Organization (WHO) began a global
vaccination program.
1980: the disease was
officially declared eradicated.

Bubonic Plague in History
“The first recorded
bubonic plague epidemic
ravaged the Byzantine
Empire during the sixth
century. It was named the
Plague of Justinian after
emperor Justinian I, who
was infected but survived
through extensive
treatment.”

“In the late Middle Ages
(1340–1400) Europe
experienced the most deadly
disease outbreak in history
when the Black Death, the
infamous pandemic of bubonic
plague, hit in 1348, killing a
third of the human population.”

In 1665-1666, the Plague hit
London killing an estimated
100,000 people; 20% of
London's population.

Human Exposure
Four (4) categories of concern related to exposures of
humans:
1. BACTERIA
2. RICKETTSIA
3. TOXINS
4. VIRUSES

Human Exposure
This program will focus on those infectious diseases caused
by:
Bacterial Agents:
Anthrax and
Plague
Viral Agents:
Ebola and
Smallpox

Bacteria
A single-celled organism. “Under
certain circumstances some can
transform into spores.”
The disease causing method can occur
in one of two ways:
1. Invading host tissues, and
2. Producing poisons (toxins)
Certain bacterium, like E. coli, can be
present in uncooked foods.

Organism-Disease
Disease-causing organism
Bacillus anthracis
Yersinia pestis
Disease Produced
Anthrax
Plague

Virus
Smaller than bacteria, a virus is able to
cause diseases ranging from the common
cold to AIDS.
“Usually consist of a protein coat with
genetic material (either RNA or DNA).
These are intracellular parasites and lack
a system for their own metabolism; they
are dependent on the synthetic machinery
of their host cells.”
“Every virus requires its own special type
of host cell for multiplication.”

Infection Transmission
Direct Contact
 Person-to-Person
 Animal to Person
 Mother to Unborn Child
Indirect Contact
Touching an infected inanimate
object then yourself without
thoroughly washing.

Infectivity
Infective doses are cited as required for the condition to affect
a person.
Examples:
Disease Infective Dose
Inhalation Anthrax 8,000 to 10,000 spores
Pneumonic Plague <100 organisms
Ebola 1-10 plague forming units
Smallpox Infective dose is assumed low

Emergency Response Guidebook
For those responding to emergencies where infectious materials may be
present, the Emergency Response Guidebook recommends:
Guide #158 for Infectious substances, affecting animals only and those
affecting humans.
Listed here are precautions for:
 Health
 Fire or explosion
 Public Safety
 Protective clothing
 Fires
 Spill or leak and
 First Aid

Anthrax
Bacteria: ANTHRAX
• Caused by bacterium Bacillus anthracis. Aerobic.
• Can be transmitted by direct contact with contaminated
wool, hides or tissues or through inhalation.
• Anthrax spores occur naturally in soil and may lie dormant
for years before ingested by domestic animals; horses, cows
and sheep as examples.

Four Types of Anthrax
 Cutaneous: through cuts or sores in skin. Those who
handle meat or hides and game animals.
 Gastrointestinal: eating infected meat.
 Inhalation (pulmonary): inhaling spores. Deadliest form
and often fatal even with treatment.
 Injection: identified in Europe with those injecting
illegal drugs from regions where naturally occurring
anthrax is common.

Cutaneous Anthrax Symptoms
Symptoms: Sores or blisters on hands and
forearms. Cutaneous is contagious.
Incubates: 2-7 days in most cases.
Fatal: Within 48 hours if untreated.
Treatment: Penicillin, immunization. Immune
serum helpful in early stages.

Intestinal Anthrax Symptoms
Symptoms: Intense stomach pain, bowel obstruction,
dehydration, diarrhea, fever; blood poisoning, death (rare in
humans).
o Exposure of the digestive system to anthrax usually by
consuming meat products that contain anthrax.
o Severe and often fatal form of anthrax. Results in death in
25% to 60% of cases.
Fatal: 1,000 spores required.
Within 24 hours of acute phase if untreated.

Intestinal Anthrax Symptoms
Incubates: 1-7 days.
Treatment: Doctors can prescribe effective antibiotics.
o Bacillus anthracis usually responds effectively to several
antibiotics including penicillin, doxycycline, and
fluoroquinolones (such as ciprofloxacin).
o To be effective, treatment should be initiated early. If left
untreated, the disease can be fatal.

Inhalation Anthrax Symptoms
Also known as Pulmonary Anthrax;
• Flu-like symptoms
• Mild chest discomfort
• Shortness of breath
• Nausea
• Coughing up blood
• Painful swallowing
Progresses to:
• High fever
• Difficulty breathing
• Shock
• Meningitis

Inhalation Anthrax
Symptoms: Initial symptoms may resemble a common cold.
After several days, the symptoms may progress to severe
breathing problems and shock. Inhalation anthrax is often fatal.
Fatal: Untreated: 90% fatal
8,000 to 10,000 spores required
Incubates: Sick in 1-5 days; sickness lasts 3-5 days
(usually fatal)
Treatment: Protective vaccine.

Plague
Bacteria: PLAGUE caused by pasturella pestis or yersinia pestis.
“Black Death” transmittable by bite of an
infected flea or person to person by
respiratory route.
 Bubonic: From rats by the bite of an infected fleas.
 Septicemic: When plague bacteria multiplies in the blood stream.
 Pneumonic: May result from septicemic form or from inhalation of
the organism.
Spreads rapidly until Hemorrhagic pneumonia involves entire lung area.
Pneumonic affects the lungs and is spread person to person by way of
cough droplets.

Plague
Type: Infection of:
 Bubonic: Lymph nodes
 Septicemic: The blood
 Pneumonic: Lungs

Bubonic Plague
• From the bite of the black rat flea.
• “Black Death” transmittable by bite of an infected flea or
person to person by respiratory route.
• This can include domesticated animals, i.e. cats to wild
animals, i.e. rabbits, rats, squirrels.
• Characterized by buboes which appear.

Septicemic Plague
This form of the disease occurs when the bacteria multiply in
the blood, causing bacteremia and severe sepsis.
Primary septicemic plague results from direct inoculation of
the bacteria into the bloodstream, typically via the bite of an
infected animal or flea or direct contact with infected tissues.
Secondary septicemic plague occurs when there is progression
of disease and dissemination of bacteria following bubonic
presentation.

Septicemic Plague
Septicemic plague is rarely transmissible human to human but
may become transmissible if the disease reaches the
pneumonic stage.
Septicemic plague, either primary or secondary, has
approximately 40% mortality when treated, and in untreated
cases, the mortality is 100%.

Pneumonic Plague Symptoms
Spread person to person by way of cough droplets.
 Cough with bloody sputum
 Difficulty breathing
 High fever
 Nausea/vomiting
 Weakness
Progresses quickly leading to respiratory failure and shock in 2 days
of infection.
Initiate antibiotics within a day of signs and symptoms or it is likely
to be fatal. May result from septicemic form or from inhalation of
organism.

Plague Symptoms
Symptoms: High fever, headache, general aches, extreme
weakness, glandular swelling, pneumonia, hemorrhages in skin
and mucous membranes possible, extreme lymph node pain.
Incubates: Bubonic, 2-6 days; unvaccinated: few days longer if
vaccinated. Pneumonic: 1 to 6 days.
Fatal: Bubonic if untreated; Pneumonic if untreated.
Treatment: Tetracycline with streptomycin.

Plague Complications
Death
Gangrene
Meningitis

Plague Risk Factors
Where you’re located
Your occupation
Hobbies

Ebola
Viral: EBOLA Virus caused by Filo virus and other African
Hemorrhagic Fevers. These are marked by severe bleeding,
organ failure and often death.
**One of the most pathogenic viruses known to science,
causing 50-90% fatalities in all clinically ill cases.

Ebola
This virus lives in animal hosts and can be contracted through
contact with blood and waste products.
It is then spread through person
to person contact with body fluids
or contaminated needles of those
infected.
Cases of transmission included direct contact with blood,
secretions, organs or semen of infected persons and by
handling ill or infected chimps.

Ebola
 Persons are not contagious until symptoms are developed.
Lack of PPE by medical personnel may be the cause of them
becoming infected.
 This should also be a concern of emergency response
personnel when working around accident victims.
 Epidemics in Africa are attributed to reusing needles and
syringes due to lack of equipment.

Ebola
Symptoms: Fever, weakness, muscle pain, headache, sore
throat. Then vomiting, diarrhea, rash, limited kidney and liver
functions & both internal & external bleeding.
Incubation:2-21 days, 5th day: hemorrhagic symptoms
Fatality: 50-90%
Treatment: Supportive care.

Ebola Symptoms
Within 5 to 10 days, may
include:
 Chills
 Fever
 Joint/muscle aches
 Weakness
 Severe headache

Ebola Symptoms
Symptoms may increase to:
 Nausea/vomiting
 Diarrhea which may be bloody
 Raised rash
 Chest and stomach pain
 Bleeding: external and internal
due to it being a Hemorrhagic
agent.

Ebola Complications
According to the Mayo Clinic staff, complications for Ebola
may include:
 Multiple organ failure
 Severe bleeding
 Jaundice
 Delirium
 Seizures
 Comma shock
Hemorrhagic fevers are lethal for a high percentage of those
infected. They interfere with the immune system’s ability to
mount a defense.

Ebola Recovery
Recovery is slow and may require months.
People may experience:
 Sensory changes
 Liver inflammation
 Weakness
 Fatigue
 Headaches eye inflammation.

Smallpox
Viral: SMALLPOX
Caused by variola virus.
Highly contagious, disfiguring
and often deadly.
No cure or treatment exists. A
vaccine exists as a preventative.

Smallpox Contracted via
 Direct contact person to person
 Indirectly via an airborne virus
 Contaminated items
 As a terrorist weapon

Smallpox Symptoms
Incubation period: 7 to 17 days during which time
you can not infect others.
Following incubation:
 Fever
 Overall discomfort
 Headache
 Severe back pain and fatigue
 Vomiting is possible

Smallpox Symptoms
A few days later, flat, red spots on your face, hands and forearms which then
appear on your trunk.
Lesions may then turn into small blisters with clear fluid
8-9 days later scabs fall off leaving deep, pitted scars.

Smallpox Symptoms
Lesions may also form on mucus
membranes of nose and mouth.
Most who contract smallpox
survive. Blindness may occur in
some.
More lethal smallpox affects
pregnant women and those with
compromised immune systems.
Lethality: High to moderate.

Anthrax Prevention
Antibiotics for those exposed to
anthrax spores.
 Cipro
 Doxycycline
 Levaquin
Vaccine for military and those in
high risk professions.

Pneumonic Plague Prevention
Affects lungs, least common
form but most deadly.
 Spread person to person
through cough droplets
(aerosolized).
 Rodent-proof your home
 Use insect repellent to kill
fleas

Ebola Prevention
Avoid contact with virus.
 Stay away from outbreak
areas.
 Wash hands frequently
 Avoid local meat sold in
their markets, if traveling
abroad
 Do NOT contact infected
persons
 Follow PPE procedures and
requirements
 Do NOT handle remains

Smallpox Prevention
 Vaccine may lessen infection if given within 4 days of
exposure.
 Childhood vaccination may provide partial immunity

Anthrax Treatment
 Antibiotic (60 day course); Cipro, doxycycline. The
antibiotic depends on how you were infected.
 Advanced inhalation anthrax may not respond to antibiotics;
the drugs may be over ridden by the amount of toxin
produced.
 Injection anthrax has been treated by surgically removing
infected tissue.

Plague Treatment
No vaccine available, antibiotics can prevent infection.
Gentamicin, Cipro, doxycycline.
If treatment is not received within 24 hours of when the first
symptoms occur, death can result.
Antibiotics: streptomycin, gentamicin, doxycycline, or
ciprofloxacin
Oxygen, intravenous fluids, and respiratory support usually are
also needed.

Pneumonic Plague Treatment
o Pneumonic plague patients should be strictly isolated from
caregivers and other patients.
o People who have had contact with anyone infected by
pneumonic plague should be watched carefully and given
antibiotics as a preventive measure.
Without treatment, about 50% of persons with bubonic plague die. Almost everyone with
pneumonic plague dies if not treated. Treatment reduces the death rate to 50%.

Ebola Treatment
No drug is approved to treat
and supportive care is
provided:
 Rehydrating
 Blood pressure
maintenance
 Oxygen as needed
 Lost blood replacement
Treating other infections
which may develop due to
suppressed immune system.

Smallpox Treatment
No cure - treat symptoms.
 Rehydrate.
 Antibiotics may be used for those who have a bacterial skin
or lung infection.
Treatment
Vaccine exists which is a preventative-not cure.
No specific therapy, supportive care must include prevention of
secondary infections.

Immunization
Agent Immunization Strategy
Anthrax Vaccine or ciprofloxacin or
doxycycline prophylaxis
Plague Vaccine or doxycycline prophylaxis
Smallpox Vaccine
Ebola No vaccine

Infectious Disease PPE
Anthrax:
Configure the necessary PPE based on the level of injury and
the point at which you make contact.
Excellent resources:
https://www.osha.gov/dts/osta/bestpractices/firstreceivers_hosp
ital.pdf
Also check:
29 CFR 1910.1030-Bloodborne Pathogens,
29 CFR 1910.132-PPE,
29 CFR 1910.134-Respiratory Protection

Pneumonic Plague:
PPE based on the level of injury and the point at which you make contact:
• Emergency Responders
• Healthcare Workers, Mortuary
Workers, and Others
• Laboratory Workers
Two (2) excellent resources:
https://www.osha.gov/SLTC/plague/controls.html and
https://www.osha.gov/dts/osta/bestpractices/firstreceivers_hospital.pdf
Also check:
29 CFR 1910.132-PPE,

Ebola PPE
Ensure adherence to the
proper personal protective
equipment requirements.
(See selection chart website
in note section: OSHA Fact
Sheet.)
Also check requirements for
other specific infectious
diseases in:
29 CFR 1910.1030-
Bloodborne Pathogens,
29 CFR 1910.132-PPE,
29 CFR 1910.134-Respiratory
Protection

Smallpox:
National infection control guidelines indicate specific
precautions when treating patients with known of suspected
smallpox. Such precautions include:
 Standard
 Droplet
 Airborne, and
 Contact Precautions
Also check:
29 CFR 1910.132-PPE,

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